MIDWIFE FINDS DELIVERANCE IN HIS JOB

HOUSTON—The baby comes sliding out, coated in white goo and chubby as an angel. A few pulls with the suction ball and he begins to wail.

Mommy weeps with joy. Daddy beams with pride.

"Congratulations, Papa," says Bill Welte, standing at the foot of the hospital bed.

"Thank you, doctor," the father replies solemnly, leaning over to shake Welte's hand.

Welte just smiles and shakes. He's not about to sit Dad down at this juncture and explain that he's not a doctor, even though he wears a white coat, works in a hospital and delivers babies for a living.

Welte is a midwife at the Center for Mothers and Babies, a maternity ward at Ben Taub Hospital in Houston's Medical Center that provides midw ife care to its clientele of primarily low-income, Hispanic women.

Today's midwife is a health professional who offers a more holistic approach to birth than that found in standard obstetric practice.

Modern midwifery is rooted in the belief that pregnancy, labor and delivery are natural things.

As a midwife, Welte is a man in a woman's world—of the nation's 6,400 certified nurse-midwives, only 60 are men.

"People say things like, 'I guess that makes you a midhusband, ha-ha-ha,"' says Dr. Susan Wente, director of the midwifery section at Baylor College of Medicine in Houston. Wente hired Welte after he'd endured repeated rejections by hospital direc tors who decided the term "male midwife" was an oxymoron.

Joke all you want: Welte loves his job and has been roundly embraced by patients at the center, who find in him a compassionate companion during one of life's most arduous tasks. Counting his time as a labor- and delivery-room nurse (another job tradition ally reserved for women), he's delivered more than 200 babies.

For the record, the word "midwife" refers to the gender of the person giving birth, not the one helping out. Literally, it means "with woman."

"The patients don't care," Welte says while doing paperwork in a cozy office reserved for the center's midwives. "They just want someone who is caring and supportive of them in labor. They don't care about gender."

Welte has the calm, soothing voice that seems a trademark of midwives.

He has smiling eyes, ruddy skin and reddish hair, thinning on top. He's open, low-key; you feel you could tell him anything. He wears hip-looking black sandals with black socks (and jokes about "midwives in Birkenstocks," referring to their stereo typical image as home-birthing, tofu-eating '60s holdovers).

He's 41 but looks younger. A married man, Welte has fought fires for the Coast Guard, led white-water rafting trips in Utah and has worked as an ambulance paramedic, but he freely admits to being "in touch with my female side."

At Ben Taub, a large public hospital, any pregnant woman who enters the system—unless she has diabetes, hypertension or other complicating factors that warrant the care of a physician—is given the choice of a midwife or an obstetrician. (Hospita l administrators value midwifery's lower cost; in addition to using fewer medical interventions, midwives earn about half as much as obstetricians.) About 1,200 babies are born in the center each year, compared to 5,000 in Ben Taub's traditional labor-and -delivery ward.

The mother-to-be of the chubby angel-baby opted for a midwife. With about an hour to go in her labor, she's in Welte's care. He checks her progress by feeling her cervix: More dilating to go. She's shaking, grimacing in pain. Earlier, when her progress st alled, Welte instructed the nurse to administer Pitocin, a drug that enhances labor but causes intense cramping. Now he orders a smidgen of Demerol to take off the edge. Instantly the woman's face relaxes, until the next contraction.

"This is still a natural birth," Welte says in hushed tones as he watches the husband rub his laboring wife's brow. "She's not numb; she can still push."

In the average labor-and-delivery room, the use of epidural medication, which numbs from the waist down, is common. In contrast, a premise in midwifery is that most women, given the right support, can do just fine without such intervention. But while the goal is unmedicated birth, the judicious use of pain medication is no longer frowned upon by most midwives, especially those who work in hospitals.

In the center—unlike down the hall, in the traditional birth ward—laboring women can walk, take showers, sip water and juice. Women labor and give birth in the same room; the baby stays with them afterward, instead of being whisked away to a nur sery.

An episiotomy—the cutting of the perineum to facilitate birth, a procedure that is routine among obstetricians—is within Ben Taub midwives' "bag of tricks," Welte says, but they don't need to use it often.

Keeping an eye on his patient, he explains how her cervix is slowly stretching to accommodate passage of the baby's head. It's a painful process. "At least I think so," he adds with a wry smile.

No, Welte has never experienced the mind-splintering joy of a contraction, nor will he ever. But, he asks, must one have a heart attack to care for heart-attack patients? The key to being an effective midwife may be not gender but something more intangibl e.

"It has to do with eye contact, touch, a kind of intuition, a certain personality or demeanor," Welte says. "A lot in midwifery can't be taught in a class. It's not for everyone and, I'm afraid, for even fewer men."

Minutes pass, and the woman's labor gets more intense. Finally, she starts huffing and pushing.

"Abre, abre (open, open)," Welte gently intones, touching her shoulder. "Imagine your body opening up and letting the baby out. Don't worry about anything. Just push."

"Respire, respire (breathe, breathe)," he says.

Unlike most obstetricians, who time their arrivals for the grand finale, midwives as a rule stick around during the more mundane but crucial work of pushing. "There's a saying in midwifery that being at bedside is worth 50 milligrams of Demerol," Welte says.

Welte grew up in Joshua Tree, Calif., surrounded by three older sisters, which he says cultivated in him "a respect for women" and a tacit understanding of the opposite sex. Though he was the baby and the only boy, his sisters cut him no slack, an other formative factor.

"I was never acculturated to view women domestically, as someone who waits on you," he says.

After graduating from high school, he wanted excitement—he's a confessed "adrenalin junkie"—so he worked as a Coast Guard damage-control man for four years. Then came the white-water rafting stint, during which he took a first-aid course to earn more money on the river. Intrigued, he became an ambulance paramedic, a job that introduced him to the adrenalin-laden world of the emergency room, where the nurses impressed him.

On the GI Bill, he earned a bachelor's degree in nursing from Humboldt State University in California, with an eye to becoming an emergency room nurse. He joined the Navy nursing corps, eventually getting a job in obstetrics/gynecology.

"I had a lot of trepidation," Welte recalls, because, by then, he'd learned that many of his female colleagues weren't too keen on the idea of a man in nursing garb.

After the Navy, Welte met Joanne Schneider, a metal smith and artist who would later become his wife, and they spent five months touring the Pacific. Then he went job-hunting. Welte went on countless interviews, only to hear the same refrain: "But we' ve never hired a male labor-and-delivery nurse before."

Finally he found a job at a small hospital in Southern California where labor-and-delivery nurses enjoyed considerable autonomy.

Welte entered the yearlong midwifery program at the University of Southern California College of Medicine—the only man in a class of 12 nurses. He also earned a master's degree in nursing, to make himself marketable beyond California.

Then came the hard part: getting hired as a midwife.

Everywhere he applied, folks looked askance at his Y chromosomes. He would see an ad for a midwife, interview for the position, be told it was filled, then see the same ad again. He likely had a good discrimination case.

"But I wasn't looking for trouble," he says. "I was looking for a job."

When he saw an ad that Wente had placed in a national midwifery newsletter, he flew to Houston for the interview.

"I had quite a few choices, and I chose Bill," Wente says. "I definitely felt here was a caring person who was committed to providing positive experiences for women coming into the center."

As a nurse and midwife, Welte has cared for thousands of women. So far, only about three have refused his services because of his gender.

Like many midwives, he finds irony in statistics that show the two groups of women who use midwives most are the college-educated affluent (drawn by the personal care and significantly lower C-section rates) and the poor (because it's cheaper). Middle Ame rica, so far, has stayed away.

And he's stumped by the idea that a woman might be uncomfortable with a male midwife but not with a male doctor.

"It's like people think doctors go through special classes to make them immune to gender differences or something," he says. "I don't know."

Publication Date : 1998-04-05

Copyright 1998 by Simon & Schuster All rights reserved. This copyright material may not be published, broadcast or redistributed in any manner.